HomeMy WebLinkAbout20071562.tiff RESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR OFFICE OF LOCAL LIAISON PROGRAM
AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Task Order Contract for the Office of
Local Liaison Program between the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Public
Health and Environment, and the Colorado Department of Public Health and Environment,
commencing July 1, 2007, and ending June 30, 2008, with further terms and conditions being as
stated in said task order contract, and
WHEREAS,after review,the Board deems it advisable to approve said task order contract,
a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Task Order Contract for the Office of Local Liaison Program between
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Weld County Department of Public Health and Environment, and
the Colorado Department of Public Health and Environment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said task order contract.
The above and foregoing Resolution was,on motion duly made and seconded, adopted by
the following vote on the 4th day of June, A.D., 2007.
B. 'D OF COUNTY COMMISSIONERS
.*, 7a r '-7 Ek OUNTY, COLORADO
�/ ,,��ATTEST:
r Q tiZ?'j E. Long, Chair
Weld County Clerk to the Bo•t. #
14.
am f �ct 4 /li H. r
BY: o-Tem
De.0 Cler o the Board, � �
Willi F. Garcia
APP D A •
AJ )
Robert D. Masden
ounty Attorney pr.s.Tk! ^ olir
ouglas'Rademacher
Date of signature: iii lu'i
2007-1562
HL0034
Memorandum
TO: David E. Long, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director)
WI DO Department of Public Health an
Environment
\��U
COLORADO DATE: May 29, 2007 n
SUBJECT: Per Capita Task Order Contract
Enclosed for Board review and approval is a task order contract between the Colorado
Department of Public Health and Environment (CDPHE) and Weld County for per capita
funding.
The State of Colorado has allocated funding pursuant to Section 25-1-516, C.R.S and Section 24-
75.1104.5 (1.5) (a) (IV) C.R.S. to provide support on a per capita basis for local and regional
health services. Weld County Department of Public Health and Environment (WCDPHE) will
administer and enforce the laws pertaining to public health and orders, rules, regulations and
standards of the State Board of Health, State Commissions and other State Regulatory bodies.
WCDPHE will also participate in assessment and planning efforts at the state, regional and local
level facilitated by the CDPHE Office of Local Liaison and submit to the CDPHE a copy of the
department's operating budget and reports of progress made towards achieving local department
goals and objectives.
The per capita funding for the time period of July 1, 2007 through June 30, 2008 will be
$338,457. Of this amount, no more than 85% of this funding is to be used to support local health
services, and at least 15% must be used to support regional health services.
I recommend your approval of this task order contract.
Enclosure
F3
1 .1 Hi
o Y?c��
l ;l 1-
1.,,) :i,�
o
C
2007-1562
r
DEPARTMENT OF PUBLIC HEALTI I AND ENVIRONMENT
ROUTING NO.08 FAA 00098
APPROVED TASK ORDER CONTRACT-WAIVER#154
This Task Order Contract is issued pursuant to Master Contract made on 12/19/2006,with routing number 08 FAA 00052
STATE.: CONTRACTOR
State of Colorado for the use&benefit of the Board of County Commissioners of Weld
Department of Public Health and County for the use and benefit of the Weld
Environment County Department of Public Health and
Office of Local Liaison Environment
(4300 Cherry Creek Drive South 1555 North 17th Avenue
Denver, Colorado 80246-1530 Greeley, CO 80631
TASK ORDER MADE DATE: CONTRACTOR ENTITY TYPE:
04/10/07 Colorado Political Subdivision
PO/SC ENCUMBRANCE NUMBER: CONTRACTOR FEIN OR SOCIAL SECURITY NUMBER:
PO FAA OLL08000098 846000813
TERM: BILLING STATEMENTS RECEIVED:
This Task Order shall be effective upon Not Applicable
approval by the State Controller, or designee,
or on 07/01/2007,whichever is later. The STATUTORY AUTHORITY:
Task Order shall end on 06/30/2008. Not Applicable
PRICE STRUCTURE: CONTRACT PRICE NOT TO EXCEED:
Quarterly $338,457.00
PROCUREMENT METHOD: FEDERAL FUNDING DOLLARS: $
Exempt STATE FUNDING DOLLARS: $338,457.00
BID/REP/LIST PRICE AGREEMENT NUMBER: MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
Not Applicable FY 08: $338,457.00
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE
Jeff Stoll Mark Wallace
Department of Public Health and Environment Weld County Department of Public Health and
Office of Local Liaison Environment
4300 Cherry Creek Drive South 1555 North 17th Avenue
Denver,CO 80246-1530 Greeley,CO 80631
SCOPE OF WORK:
The state shall provide support on a per capita basis for local and regional health services of which no
more than eighty-five percent shall be for supporting local health services and not less than an
additional fifteen percent of supporting regional health services.
Page 1 of 4
EXHIBITS
The following exhibits are hereby incorporated:
Exhibit A- Additional Provisions (and its attachments if any—e.g.,A-1,A-2, etc.)
Exhibit B- Statement of Work and Budget(and its attachments if any—e.g.,B-1,B-2, etc.)
Exhibit C- Limited Amendment Template for Task Orders
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made
more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task
Order Contract provide more specificity than these general clauses,the more specific provision shall control.
This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including,but not limited to,Exhibit One thereto. The total term of this Task Order Contract, including
any renewals or extensions, may not exceed five(5)years. The parties intend and agree that all work shall
be performed according to the standards,terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(1),C.R.S.,as amended,this Task Order Contract is not valid until it
has been approved by the State Controller, or an authorized delegee thereof. The Contractor is not
authorized to, and shall not;commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or,any costs or expenses, incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date,then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date,then the Contractor shall only commence performance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract, unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated,all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract(including its exhibits
and/or attachments),or between this Task Order Contract and its exhibits and/or attachments,such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: 1)the
Special Provisions of the Master Contract;2)the Master Contract(other than the Special Provisions)and its
exhibits and attachments in the order specified in the Master Contract;3)this Task Order Contract;5)the
Page 2 of 4
Additional Provisions-_Exhibit A,and its attachments if included,to this Task Order Contract;4) the
Scope/Statement of Work-Exhibit B,and its attachments if included,to this Task Order Contract;6)other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner,all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference,made a part hereof and
attached hereto as"Exhibit B".
5. The State,with the concurrence of the Contractor, may, among other things,prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from,and/or modify this
Task Order Contract's Statement of Work through a"Limited Amendment for Task Orders"that is
substantially similar to the sample form Limited Amendment that is incorporated herein by this reference
and identified as Exhibit C. To be effective,this Limited Amendment must be signed by the State and the
Contractor,and be approved by the State Controller or an authorized delegate thereof. Upon proper
execution and approval,this Limited Amendment shall become a formal amendment to this Task Order
Contract. This contract is subject to such modifications as may be required by changes in Federal or State
law, or their implementing regulations. Any such required modification shall automatically be incorporated
into and be part of this Task Order Contract on the effective date of such change as if fully set forth herein.
6. The conditions,provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto,or any attachments or exhibits thereto,or the Scope/Statement of Work
Exhibit B,establishes or creates standards of performance greater than those set forth in the RFP,then the
Contractor shall also meet those standards of performance under this Task Order Contract.
Page 3 of 4
IN WITNESS WHEREOF, the State has executed this Task Order Contract as of the day first above
written.
CONTRACTOR: STATE OF COLORADO:
Board of County Commissioners of Weld County BILL RITTER,JR. GOVERNOR
for the use and benefit of the Weld County
Department of Public Health and Environment
Legal Name of Contracting Entity £i9T)\k`n (-4-----
For Executive xe Director
846000813 Department of Public Health and Environment
Social Security Number or FEIN
O g Department Program Approval:
Signature of Authorized Officer`1\a N 0 4 2001
David E. Long, Chair By
Print Name&Title of Authorized Officer
GOVERNMENTAL ENTITIES: NC A ' t ",
(An attestatio and s a ar re u% �` r> ,
4 1841 1 �c . t
Attest(Seal)B I a 6 t ", itt
(Town/City/Coup Clerk Equivalent) Dh Q o' ment seal here)
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State
Controller,or such assistant as he may delegate,has signed it. The contractor is not authorized to begin performance until
the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be
obligated to pay for the goods and/or services provided.
STATE CONTROLLER:
Leslie M.Shenefelt
By
Date U 3 t.
WELD COUNPUBLIC HOALT�A DEPARTMENT OF
NV AE7
Mark E. Wallace, MD, MPH-Director
Page 4 of 4
XO0 7- /5 6 a
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 04/10/2007 - Contract Routing Number 08 FAA 00098
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
The State has determined that this contract does not constitute a Business Associate relationship under
HIPAA.
2. This Task Order Contract contains state funds.
3. Compensation under this Task Order Contract. The contractor will receive automatic quarterly payments
within thirty(30)calendar days after the quarter ends. Payment during the initial, and any renewal or
extension,term of this Task Order Contract shall be conditioned upon affirmation by the State that all
services were rendered by the Contractor in accordance with the terms of this Task Order Contract.
4. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty (30)calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable,or is otherwise deficient,then the State shall notify
the Contractor of the failure or deficiencies, in writing,within thirty(30)calendar days of: 1)the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery;or 2)the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable,the Contractor shall have a reasonable period of time,not to exceed thirty(30)
calendar days,to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within thirty(30)calendar days,the Contractor shall be in default of its obligations under this
Task Order Contract and the State,at its option,may elect to terminate this Task Order Contract or
the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract.
5. Survival of Certain Contract Terms. Notwithstanding anything in this contract to the contrary,the parties
understand and agree that all terms and conditions of this contract which may require continued
performance,compliance, or effect beyond the termination date of the contract and shall survive such
termination date and shall be enforceable by the State as provided herein in the event of failure to perform
or comply by the Contractor.
To be attached to CDPHE Page 1 of 1 Revised: 12/19/06
Task Order v1.0(11/05)contract template
EXHIBIT B
STATEMENT OF WORK
To Task Order Contract Dated 04/10/2007-Contract Routing Number 08 FAA 00098
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above.
1. The Contractor, in accordance with the terms and conditions of this contract, shall perform and complete, in
a timely and satisfactory manner,all activities described in the approved Statement of Work and Budget
that is attached hereto as Attachment B-1 and incorporated herein.
2. The Contractor will be required to submit reports as required and outlined in the statement of work,
Attachment B-1.
To be attached to CDPHE Page 1 of 1 Revised: 12/19/06
Task Order v1.0(11/05)contract template
Attachment B-1
Weld County Statement of Work and Budget
The Office of Local Liaison desires to strengthen the capacity to provide public and environmental health services in Colorado.
The current practice of Public Health uses the core public health functions model(assessment,assurance,and policy
development)as a framework for organizing, delivering, and evaluating interventions aimed at improving health. "The
Operational Definition of a Functional Local Health Department"by the National Association of City and County Health
Officials delineates and describes the core public health functions and services. This model can be referenced to guide strategic
decisions for provision of public health services within a jurisdiction.
This scope of work is designed to:
1. Provide accountability to assure State monies are being used effectively for Basic and Optional Public Health
Services,as define by the Colorado BOLL
2. Develop and maintain a consistent planning framework that integrates local efforts to mobilize their communities
and address public health issues with state initiatives.
3. Inform state level decisions and policy development.
4. Build state and local partnerships focused on strengthening Colorado's public health system.
5. Identify areas in the state system that need improvement to better support local agencies through the state system
functions of 1)Planning and Implementation;2)Technical Assistance and Support; 3)Evaluation and Quality
Improvement;and 4)Resources.
It is hereby agreed that for and in consideration of their mutual promises to each other,hereinafter stated,the parties hereto
agree as follows:
1. Local Health Services. The local health department shall use these moneys to provide support for basic and optional
public health services,as defined by the State Board of Health in accordance with Section 25-1-516 C.R.S. and Section 24-
75.1104.5 (1.5)(a)(IV)C.R.S. A copy of the current definition of basic and optional public health services shall be posted
at the Office of Local Liaison website.
The current practice of Public Health uses the core public health functions model(assessment, assurance,and policy
development)as a framework for organizing,delivering,and evaluating interventions aimed at improving health. The ten
essential public health services,outlined in the"The Operational Definition of a Functional Local Health Department"by
the National Association of City and County Health Officials delineate and describe the core public health functions. This
model can be referenced to guide strategic decisions for provision of public health services within a jurisdiction.
2. Regional Health Services. The State shall provide support on a per capita basis of which no more than 85%shall be for
supporting local health services and not less than an additional 15%for supporting regional health services.
A. According to Section 25-1-516, C.R.S., regional health services shall be construed to mean two or more local
county or district health departments or county boards of health providing joint services.
B. The contractor understands and hereby agrees that the State Board of Health shall have review power over the
formation,establishment and support of regional health services.
3. Statewide,Regional and Local Planning. The local health department shall participate in assessment and planning
efforts at the state, regional and local level facilitated by the Office of Local Liaison(Colorado Public Health Performance
Improvement Plan). These efforts shall include maintaining and improving local capacity to provide essential services
outlined in"The Operating Definition of a Functional Local Health Department"by the National Association of
City/County Health Officials and"Basic and Optional Public Health Services"defined by the State Board of Health.
A. Agency Representative. Each agency will designate someone to represent the agency in planning meetings and
work with the OLL as needed in developing statewide plans.
B. Community Health Assessment(Optional). The Contractor is encouraged to perform a community health
assessment at least once every five(5)years or in any other frequency that is consistent with current accepted
public health practice and standards.
C. Annual Community Health Plan (Optional). The Contractor is encouraged to develop a community health plan to
respond to a community assessment.
4. Reports and Audits. The contractor shall provide to the State the following information as specified. The quarterly
advance of funds for the period April, May and June of the current fiscal year shall be withheld until all reports are
received by the State. The contractor shall maintain such records as may be necessary to provide the information herein
required by the State and submit to such reasonable audits and evaluations as may be necessary.
A. Local Health Department Financial Report An agency financial report for the previous calendar year shall be
submitted by April 1,2008. A template shall be provided by the OLL and posted on the OLL website.
B. Community Health Assessment. A copy of any completed community health assessment(s)shall be submitted to
the OLL upon completion.
C. Annual Community Health Plan(Optional). The Contractor is encouraged to submit an"Annual Community
Health Plan"to the Office of Local Liaison. The Annual Community Health Plan could consist of three parts as
follows:
1) Contractors opting to submit its Annual Community Health Plan are encouraged to do so on or before
January 31. A reporting template will be provided on the OLL website. The Annual Community
Health Plan could include,but is not limited to,the following information:
a) An outline of the Contractor's goals and objectives for the calendar year covered by the Plan
to address the primary local public health issues identified in the a community assessment or
other assessments submitted in response to 4.B. of this Scope of Work;
b) The public health interventions and supporting basic and optional public health services that
the Contractor intends to provide in the calendar year covered by the Plan to meet the annual
goals and objectives;
2) The Contractor is encouraged to collaborate with the OLL to identify any short or long-term support
needs from the State to build capacity to provide basic and optional public health services.
D. Annual Progress Report. An Annual Progress Report shall be completed and submitted for the previous calendar
year by April 1,2008. The OLL will provide technical assistance as needed. The report shall discuss:
1) The progress made on priority health needs of the community.
2) The effectiveness of basic and optional public health services shall be discussed; and
3) Success stories provided as appropriate to demonstrate the effective use of these funds;and
4) A description of how 15%of funds were expended on regional services.
5) A description of how the agency utilized 85%of funds for local health services.
5. Supplanting of Funds. In order to qualify each county and city and county shall comply with the statutory requirements
for contribution as set forth in C.R.S. § 25-1-516 for its local health services. Each board of health may contribute such
additional amounts as it may determine to be necessary to meet their local health needs.
6. Payment. Payment equal to(1/4)of the total allocation shall be paid automatically in the last month of each quarter as
follows:
Quarter Amount
July 1 through September 30,2007 $84,614.00
October 1 through December 31,2007 $84,614.00
January 1 through March 31, 2008 $84,614.00
April 1 through June 30,2008 $84,615.00
EXHIBIT C
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
(ADD PROGRAM NAME HERE)
DEPARTMENT OR AGENCY NUMBER
***
CONTRACT ROUTING NUMBER
LIMITED AMENDMENT#*
This Limited Amendment is made this **** day of*********,200*,by and between the State of Colorado, acting
by and through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal
place of business is 4300 Cherry Creek Drive South, Denver,Colorado 80246, hereinafter referred to as the
"State"; and, LEGAL NAME OF ENTITY,(legal type of entity),whose address or principal place of business is
Street Address,City, State& Zip Code, hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The parties entered into a contract dated ******** ** ****, with contract encumbrance number PO ***
**********, and contract routing number** *** *****, whereby the Contractor was to provide to the State the
following:
[briefly describe what the Contractor was to do under the original contract—indent this paragraph'
I Please choose one of the following four options and then delete this heading and the other three options not
selected:I
The State promises to [choose one and delete the otherlincrease/decrease the amount of funds to be paid to the
Contractor by ********** Dollars,($*.**)during the current term of the Original Contract in exchange for the
promise of the Contractor to perform the (choose one and delete the otherlincreased/decreased work under the
Original Contract.
The State promises to pay the Contractor the sum of********** Dollars,f$*.**) in exchange for the promise of
the Contractor to continue to perform the work identified in the Original Contract for the renewal term of""
years/months, ending on ******** **, ****.
The State promises to 'choose one and delete the otherlincrease/decrease the amount of funds to be paid to the
Contractor by********** Dollars,f$*.**)for the renewal term of**** [choose one and delete the
other years/months,ending on ******** **, ****, in exchange for the promise of the Contractor to perform the
(choose one and delete the otherjincreased/decreased specifications to the Scope of Work described herein.
The State hereby exercises a"no cost"change to the 'insert those that apply and delete those that don'tlbudget,
specifications within the Scope of Work, project management/manager identification, notice address or
notification personnel,or performance period within the (choose one and delete the othericurrent term of the
Original Contract or renewal term of the Original Contract.
NOW THEREFORE, in consideration of their mutual promises to each other,stated below,the parties hereto agree
as follows:
1. Consideration for this Limited Amendment to the Original Contract consists of the payments and services
that shall be made pursuant to this Limited Amendment,and promises and agreements herein set forth.
2. It is expressly agreed to by the parties that this Limited Amendment is supplemental to the original
Page 1 of 4
contract,contract routing number** *** *****, (insert the following language here if previous
amendment(s), change order(s), renewal(s)have been processedlas amended by (include all previous
amendment(s),change order(s), renewal(s)and their routing numbers(, (insert the following word
here if previous amendment(s), change order(s), renewal(s) have been processedlcollectively referred
to herein as the Original Contract, which is by this reference incorporated herein. All terms,conditions,
and provisions thereof, unless specifically modified herein, are to apply to this Limited Amendment as
though they were expressly rewritten, incorporated, and included herein.
3. It is expressly agreed to by the parties that the Original Contract is and shall be modified, altered, and
changed in the following respects only:
A. 'Use this paragraph when changes to the funding level of the Original Contract occur
during the current term of the Original ContractiThis Limited Amendment is issued pursuant
to paragraph *_**.of the Original Contract identified by contract routing number** *** *****.
This Limited Amendment is for the current term of********* ** ****,through and including
********* ** ****. The maximum amount payable by the State for the work to be performed by
the Contractor during this current term is (choose one and delete the
otherlincreased/decreased by ********** Dollars, ($*.**) for an amended total financial
obligation of the State of********** DOLLARS,(5*.**). [delete any portion of this sentence
that is not applicable'The revised specifications to the original Scope of Work and the revised
Budget, if any,are incorporated herein by this reference and identified as"Attachment *"and
"Attachment *". The first sentence in paragraph *_**.of the Original Contract is modified
accordingly. All other terms and conditions of the Original Contract are reaffirmed.
A. [Use this paragraph when the Original Contract will be renewed for another termlThis
Limited Amendment is issued pursuant to paragraph *_**. of the Original Contract identified by
contract routing number** *** *****. This Limited Amendment is for the renewal term of
********* ** ****,through and including********* **, ****. The maximum amount payable
by the State for the work to be performed by the Contractor during this renewal term is
********** Dollars, ($*.**)for an amended total financial obligation of the State of**********
DOLLARS,($*.**). This is an (choose one and delete the otherlincrease/decrease of
********** Dollars,($*.**)of the amount payable from the previous term. (delete any portion
of this sentence that is not applicablelThe revised specifications to the original Scope of Work
and revised Budget, if any, for this renewal term are incorporated herein by this reference and
identified as"Attachment *" and"Attachment *". The first sentence in paragraph *_**.of the
Original Contract is modified accordingly. All other terms and conditions of the Original Contract
are reaffirmed.
A. 'Use this paragraph when there are"no cost changes" to the Budget,the specifications
within the original Scope of Work,allowable contract provisions as noted,or performance
period.(This Limited Amendment is issued pursuant to paragraph *_**.of the Original Contract
identified by contract routing number** *** *****. This Limited Amendment 'choose those
that apply and delete those that don'tlmodifies the Budget in 'identify location in contract',
modifies the specifications to the Scope of Work in [identify location in contract',modifies
the project management/manager identification in 'identify location in contract',modifies
the notice address or notification personnel in [identify location in contract',modifies the
period of performance in 'identify location in contract' of the Original Contract. The revised
'choose those that apply and delete those that don'tlBudget,specifications to the original
Scope of Work,project management/manager identification,notice address or notification
personnel,or period of performance is incorporated herein by this reference and identified as
"Attachment *". All other terms and conditions of the Original Contract are reaffirmed.
4. The effective date of this Amendment is date,or upon approval of the State Controller,or an authorized
delegate thereof,whichever is later.
5. Except for the General Provisions and Special Provisions of the Original Contract, in the event of any
Page 2 of 4
EXHIBIT C
conflict, inconsistency, variance,or contradiction between the terms and provisions of this Amendment and
any of the terms and provisions of the Original Contract,the terms and provisions of this Amendment shall
in all respects supersede, govern, and control. The Special Provisions shall always control over other
provisions of the Original Contract or any subsequent amendments thereto. The representations in the
Special Provisions to the Original Contract concerning the absence of personal interest of state of Colorado
employees is presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR
ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED,
AND OTHERWISE MADE AVAILABLE.
Page 3 of 4
IN WITNESS WHEREOF, the parties hereto have executed this Form Amendment on the day first above written.
CONTRACTOR: STATE:
[LEGAL NAME OF CONTRACTOR] STATE OF COLORADO
(legal type of entity) Bill Ritter,Jr. Governor
By: By:
Name: For the Executive Director
Title: DEPARTMENT OF PUBLIC HEALTH
FEIN: AND ENVIRONMENT
ATTEST: PROGRAM APPROVAL:
If the Contractor is a corporation
or governmental entity, then an attestation By:
is required.
(Seal,if available.)
By:
City,City and County,County,
Special District,or Town Clerk or Equivalent
Corporate Secretary or Equivalent
[Delete inapplicable language.
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS 24-30-202 requires that the State Controller approve all state contracts. This limited amendment is not
valid until the State Controller,or such assistant as he may delegate,has signed it. The contractor is not
authorized to begin performance until the contract is signed and dated below. If performance begins prior to
the date below,the State of Colorado may not be obligated to pay for goods and/or services provided.
STATE CONTROLLER
Leslie M. Shenefelt
By:
Date:
Form: LAT 7-I-04GN
Page 4 of 4
STATE OF COLORADO
Bill Owens,Governor
Dennis E. Ellis, Executive Director of coto
441
Dedicated to protecting and improving the health and environment of the people of Colorado r°' % q1
4300 Cherry Creek Dr. S. Laboratory Services Division c* " +a
Denver,Colorado 80246-1530 8100 Lowry Blvd. '1876
Phone(303)692-2000 Denver,Colorado 80230-6928
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
http://www.cdphe.state.co.us and Environment
July 12, 2007
Weld County Department of Public Health & Environment
Attn: Mark Wallace
1555 North 17th Avenue
Greeley, CO 80631
Dear Mr. Wallace,
Enclosed is your copy of the fully executed Per Capita contract with the Office of Local Liaison at the
Colorado Dept. of Public Health and Environment.
Please contact me if you have any questions relating to the finance aspect of this contract or you may
contact Jeff Stoll at (303) 692-3479 for any technical questions relating to your project.
Thaq you,
n��, d al —.
Tracey Clary
Contracts Manager
Administration & Financial Services Division
(303) 692-2154
tracev.clark a state.co.us
Hello